Love My Community Application

Please fill in as much information as you can.

Our management team reviews the applications every month and we will notify you by email or phone if your application has been successful or we need more information. Choose your words carefully, as we love to use them for our in house marketing of your Local Group or Charity!

Good Luck, and thanks for contributing!!!

* Required

Title

First Name *

Last Name *

Email Address *

Phone Number *

Local Group/Charity *

What is your relation to the Group/Charity *

ABN of Group (If Known)

Size of Group

Address

Website or FB Page

Which Clinic is Nearest the Group? *

Describe what your group does (50 words) *

Describe how extra funds may be used to help (50 words) *

I am happy to be contacted if necessary *

All the information provided is true to the best of my knowledge *

By submitting this form, you accept our privacy policy. We may need to contact you regarding some of the information provided.
All applicants must have a valid ABN

If you have any supporting files, please attach them here (250Mb Limit)